Healthcare Provider Details

I. General information

NPI: 1316126378
Provider Name (Legal Business Name): LYNETTE BRENDA FELDPAUSCH BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 S BROADWAY
ENGLEWOOD CO
80113-1526
US

IV. Provider business mailing address

2955 S BROADWAY
ENGLEWOOD CO
80113-1526
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-1118
  • Fax: 303-788-1222
Mailing address:
  • Phone: 303-788-1118
  • Fax: 303-788-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number126656
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: